Travis County Commssioners Court
January 13, 2004
The Closed Caption log for this Commissioners Court agenda item is provided by Travis County Internet Services. Since this file is derived from the Closed Captions created during live cablecasts, there are occasional spelling and grammatical errors. This Closed Caption log is not an official record the Commissioners Court Meeting and cannot be relied on for official purposes. For official records please contact the County Clerk at (512) 854-4722.
Item 18
Number 18 is receive update and take appropriate action on Travis County employee wellness program. By the way, you all, number 21, I thought I would just put this on and provide the backup for us to start thinking about that. Want to take action next week on 21. That was my intention, to give us a week to think about it.
>> could I make a request so people could think about it?
>> uh-huh.
>> on the 911 regional communication center, Commissioner Gomez is the only one that's slated. I would like to be considered, if you all -- since I have nine of the e.s.d.s, I don't think any of the e.s.d.s are going to play into that, just for everybody's consideration.
>> okay. Now, the wellness committee members, if you are here, come forward. Number 18. Receive update, take appropriate action on Travis County employee wellness program. 21 we'll have back on next week for action.
>> they are taking the stairs so it's taking a little longer.
>> now, for the members of the Travis County attorney's office, we will reach executive session in just a few moments.
>> good morning. Alicia perez. We're here with our wellness committee and in response to a court mandate to look at wellness as a resource, as an avenue for trying to cut our health care costs. We do have the committee and have been meeting every week. We submitted a memorandum to you that outlines what the committee has done and some of the ideas and activities that we have planned in the future for all employees. The committee report, you had given us several directives, and we would like to just go -- quickly go over what we have already done. We sent a letter to employees about health car and wellness and emphasized the need for each employee to take responsibility for their health care and how that in the coming budget years may be taken into consideration or will be taken into consideration in terms of determining a pay increase for their -- whether we can afford both the quality health care that we offer now and increasing individual salaries. We did an employee survey that was completed and we'll share -- talk a little more about that information as we go through the report. Our first bimonthly windows on wellness newsletter is now on the intranet. We will send a notice to all employees this week about the news letter. It really turned out very, very well. There is a lot of written sound bytes on information that helps people lose weight and also information on websites that individuals can go to. But it is filled with good information on how one can improve health and wellness.
>> do we all know thousand access the Travis County intranet?
>> when we send out the notice to employees, will you be able to just to click on the particular newsletter and get access to it.
>> okay. If we're not clicking on something, do we know thousand access intranet?
>> it's tc -- I hate to say because I'm not a good web person.
>> tc.net.
>> thank you.
>> and the public announcement should have the link. We're also having hard copies printed and they will go to the departments for dissemination to staff through the department liaisons.
>> and we'll have instructions on there also how to get to it via just your regular internet line. We have volunteer group leaders for walking groups, both myself and jane will participate in that in the central campus, and we hope to get other group leaders in the outlying offices also. We have a volunteer, susan, month most of you know has been very successful, and he doesn't smoke anymore, so he has volunteered to be a group leader for a support group on smoking cessation. We have the health care festival that will be held February 12. I believe that is a Thursday. And that will be in the granger building and available to everyone. And this is not a one-time event. We hope to take this show on the road and do a health care festival in each of the outlying facilities that have county staff. We have several pilot projects that will be offered immediately after the festival. And do you want to talk about your short term and long term?
>> well, did you all skip the exercise and training sites? Or did I miss it?
>> no, we've got it addressed later on. In terms of the training sites. And it's discussed in terms of what we want to do also with reimbursement of that particular activity.
>>
>> [one moment, please, for change in captioners]
>>
>> ... Different departments that may have employees probably as far as attending the one that we are going to have on the 12.
>> yes, sir.
>> how do you --
>> what we would like to do is work -- not only with t.n.r., But the tax office, the county clerk's office.
>> right.
>> you know, cscd's constables office for some outlying facilities where we have employees at, to work with them to put on a health care festival in that particular facility. So this is a kickoff, but then we take the show on the road and be able to provide the same activities in those facilities.
>> okay. Thank you.
>> okay? In fact, if you would please pass out the maps so on -- in terms of responding to Commissioner Gomez's question of the sites for gyms and other facilities, I will go ahead and have lee mccormick, one of our trainers and safety engineers, pass that out, he's been working on that item. So those of you who don't know, lee also played professional football with [multiple voices]
>> but.
>> health care festival will be held February 12th, here in the granger building. At the current time we have about 15 booths that will set up anywhere from -- they will be from signing up for the programs, the pilot projects, the walking groups, nutritional groups as well, demonstrate how to prepare nutritional -- [multiple voices] -- making green beans taste like pork chops, things like that.
>> green beans are okay, brussel sprouts you need to getid of [laughter]
>> that may be what we'll do. But we anticipate good variety of wellness features at this particular festival. And as alicia said we want to make the resources and programs available to outer offices and facilities. The -- the -- we will bring back to the court next week a --
>> I didn't hear anything that you said.
>> oh.
>> okay. I defer to lee because he's bigger. [laughter]
>> okay. The festival will be held February 12th. And we have approximately 15 booths that will be set up, there will be demonstrations of everything from preparing nutritious and good tasting meals to signing up for a different project, pilot projects, including Austin diagnostic program for health risk management and we will have some speakers on -- who will be coming in. We are looking for doctors who will come in and speak on cardiovascular disease, cardiopulmonary disease, diabetes, we will have our e.a.p. Vendor here to talk about stress management. We anticipate a full day. We will also have theions' club mobile screening van here, they will be doing screenings, we encourage everyone to come down, come down early for that. On our -- our longer term objective, we are still -- we are still studying, but we have under consideration to bring back to the court a recommendation for an employee health clinic that will be located on site. This clinic will be for treatment of acute illnesses, it would be to conduct regular lab screenings, as follow up to -- to programs that they [papers shuffling - audio interference] enroll in, to serve really wellness based operation that's we think is critical to the success of any comprehensive wellness program which I what I think the committee is trying to design. We would also be following up with some education for our support group leaders. We want them to have resource that's they can go to and feel comfortable as they are leading groups of individuals, whether it's in walking or smoking cessation, weight loss, those type of programs. We want to develop a buddy system if all of a sudden I have an urge to have a -- a corn beef and cabbage sandwich, I can call somebody say "i'm having this urge, talk me out of it" if I'm going to light up that pipe, maybe get talked out of it. We want to have a train the trainer program, so if we are perpetuating the groups within each department who can take on some of the responsibilities and be team leader and group leaders. Then we are looking at health consumer education, we want to emphasize to employees that benefits are there to use, use them wisely, be a good consumer. Early detection of disease, how to research disease and treatments, documenting symptoms before you go to the doctor so you can relate accurately what your symptoms are, and so that can be the best provider for -- to treat your condition, whether it's cardiovascular disease, diabetes, stress or healthy babies.
>> of the short-term objectives, we are talked about the newsletter, health care festival, exercise and training and let's go for the project development. There's one other issue that we would like to run by the court and get your sense of how you would like us to proceed. Several of the classes that we are teaching will be taught by individuals, employees of the county that have volunteered to teach the classes. The committee talked about providing a stipend or an hourly pay compensation for individuals that will go above and beyond their normal work responsibilities and we are not talking about -- about leaders for walking groups. We are talking about specifically a -- nutrition, training, physical training. For example, if we did a -- if we did a class that was an after hours class or during lunch on diabetes and we had a nurse from either gardner-betts or the Travis County correctional facility come out to teach it, that we would like to be able to provide them 7 a stipend -- provide them a stipend, whether it's $15 an hour or $10 or $12 or 18, we don't have a job description yet, we don't have a market match for what that sort of trainer would cost. But that is a discussion that we did have in the committee and thought that we would recommend to the court for us to develop that particular idea.
>> alicia, are we thinking about specialists in different areas? I have been diabetic about 12 or 13 years, I know a lot about diabetes, but I would go see a nurse who is a specialist in diabetes. See what I'm saying? Now, how -- not saying that I would know more than a general practitioner --
>> sure.
>> -- but I think my questions would be very, very specific. In fact I got 10 or 12 already. But I don't know that a nurse who is a general practitioner would help me that much. See what I'm saying?
>> uh-huh, sure.
>> so is our focus, the person who comes to talk about high blood pressure, I mean, I would think that we would try to track practitioners who have a special expertise in a given area. Don't you think?
>> absolutely. But would also want to have that nurse come in and perhaps do some training at one of the t.n.r. Substations or precinct 4 on if nutrition. If we were asking her to do that above and beyond what her normal work hours, we would like to be able to offer some sort of a stipend or pay. So they wouldn't be -- you may get a nurse that has particular training in -- in diabetes that would be able to come and provide has class, that's kinds of what we are focussing on.
>> I think we ought to be prepared to pay for special expertise.
>> okay.
>> kind of like nutrition and there is nutrition for diabetics. Right?
>> yes.
>> and there is good nutrition that we all hear about in elementary school. I don't know that we ought to pay extra to get that. I think we ought to encourage employees to read magazines and do good. But in terms of -- who ought to eat, ought not to -- what you ought not to eat if you have high blood pressure that's a little different. Diabetes, I know there are common foods, but I think there are some things that you really ought to aim towards, somehings that you ought to stay away from. I think that ought to be our focus.
>> absolutely. People that have education, training, and a background in the particular area that they are going to train in, just like we would require of anyone that we hired to do that particular job.
>> okay.
>> have we identified a source of funding for this, or do we think that we are looking at the allocated reserve.
>> well, we have discussed the allocated reserve, it just depends on how much we spend. In the last couple of years, we have not spent all of our tuition reimbursement funding. So I think to start off with, we can use some of that funding to pay for this. And the more successful it gets in terms of more people attending and more individuals that we have to pay to provide the classes or the variety of classes, then we can come back and look at allocated reserve. Right now in the kickoff I think that we have some money in tuition reimbursement that we may be able to use.
>> p.b.o. Recommended that we look at the health fund that is kind of like matching revenue and expense. You would expect a wellness ram to cut down on the claims expense in the long run, therefore you match that expense of the wellness program with the fund that supported wellness claims. I don't know if barbara was able to research that for us.
>> I'm sorry, I did not get that done.
>> okay.
>> the wellness part is not in the risk management fund, it's straight.
>> no. Health insurance fund is what the p.b.o.'s recommendation would be.
>> that would seem to be a more logical choice than reimbursement, either a health fund or allocated reserve. When we budget rebest of my knowledge yourselfment, we budgeted in an amount that I thought we might reach, I hope.
>> I didn't say, we just have not been doing it in the last year. We wanted to make everything easier, but we can look at that and have barbara take a look at that.
>> all right.
>> talk about the wellness pilot projects.
>> if you will refer to page 3 of the handout, the first pilot project is for cardiovascular disease and diabetes, there are six different sessions that comprise this particular project and if -- if an employee enrolls in the project, it would be expected to attend the six sessions and hopefully learn and practice, be implementing what they have learned and practice this on a day-to-day basis. Once the project has been completed, they would receive a certificate of -- of appreciation, an award, and we are still looking at different awards that could be presented to the employees who successfully complete these projects. But certainly they would be given recognition in addition to feeling better and -- and hopefully being happy with their accomplishments. Page 4 is the second pilot project, it focuses on asthma, cardiopulmonary lung disease and would include smoking cessation, these projects can be offered at the same time. They are not necessarily one to follow the other. They can be -- you can sign up for those just as you would the walking groups. The same principle would apply to this project. It would be six different sessions covering everything from solving an asthma puzzle to stop smoking cessation, exercise and daily physical activity. How to avoid stress and choosing food wisely, those are some of the courses within this project. Again, once an employee completed that project, they would receive a certificate of appreciation and possibly some additional award that would be given.
>> we are going to discuss the sample of pilot project 3, she's very familiar with the program and this is a program at Austin diagnostic clinic.
>> thank you. My name is jane frank, I work for Travis County in i.t.s. The reason that we have asked the Austin diagnostic clinic to come to our health fair is because there have been several Travis County employees, including myself, that have enrolled in this particular project with Austin diagnostic clinic, it's a 13-week program, it has be very, very successful. Very successful. I have been in it for over a year and a half now. Successfully lost 65 pounds, managed to keep it off for a year now. There are currently, I know, five Travis County employees right now in the immediate area of downtown campus that are currently going to it. They do offer a free one hour orientation. So rather than have our employees go to them, they have agreed to come to our wellness fair, they are going to set up a booth, they are also going to offer two orientation -- one-hour orientations, one in the a.m., One in the p.m. And we are real excited about having them here.
>> this is a weight loss program that can be covered through our health insurance if it is related to a particular or potential chronic disease.
>> is that weight loss with a focus on diet or diet and exercise.
>> both.
>> okay. Health-wise, health care book. Who is that by?
>> I see where --
>> we looked at purchasing -- if the court remembers, when we were with the Texas association of counties, they provided health-wise health care book, it's a reference to be used for researching particular elements or diseases. It was a book that went owe -- that employees appreciated very much and used. We looked at purchasing those, I think that we found that the cost was quite high for that particular book. There are others out there that probably are less expensive and do just as good. But we are still researching that, I don't know that a final, committee -- committee has made final decision.
>> how much does it cost?
>> judge, I can't remember the exact cost per book.
>> we can get that information for you.
>> we can get that, bring it back next week.
>> are we trying to put together a list of publication that's employees can acquire on their own?
>> I think we are trying to do that as resource in the newsletter and showing in the newsletter different books and places that employees can go to research medical conditions, nutrition.
>> everybody who was here during the tax experience still -- tak experience still should have their book. I bring mine at least once a week. We have still got our books.
>> it was suggested that perhaps with the bi-monthly newsletter that a book review be part of the newsletter, so that individuals who read books on wellness or health are able to participate by submitting a book review. And recommending that particular book to other employees. So I know we are doing that.
>> okay. Travis County employee wellness program, we also have other pilot projects and activities that we will be promoting. Among them the walking exercise group and we talked about that, having volunteers lead some of that, using walk across Texas maps and pedometers, also we talked about the body composition and, lee, do you want to talk about some of these? I think -- some of those are your bailiwick in terms of the exercise and the different gyms that we contacted and the city of Austin for possible discounts on memberships.
>> as far as the exercise facilities, I have given you a list of all of the locations and the prices of each facility and they all have showers and pretty reasonable in their prices for employees per month. But the -- with the pilot program we also want to start employees on the right track and give them some type of instruction on exercises and what to do and what not to do, most people don't like to stay in the gym more than 45 minutes. So we will try to put something together, or should I say we are going to have something put together where they will number the weight room for 20 -- they will be in the weight room for 20 minutes and combine that with the cardio work, give them 45 to an hour every other day or -- however they might exercise. On the risk management side, we offer them -- dan discussed about the first 100 people who signed up for some of the pilots, getting personal training at no charge at one of the facilities. So we're still talking about that. Trying to see how we want to handle that and issue that to the employees. But other than the exercise program, once they get there and get established on what they need to do and what's good for them and what they shouldn't do, it should be pretty easy transition. Work out in between their walking and their other exercises and nutrition plan.
>> okay. Dan, do you want to go ahead and go through the cost? One of the things that we did was take a look at potential cost or these are estimates for what the activities would -- would cost us. We have done a lot, I think, on no money. The newsletter will be published very little cost other than staff time. And some paper. The -- the walking groups, a lot of those and most of those will be done by volunteers. That will volunteer to take a lead on at least gathering the folks that want to walk. The program at weight management program at Austin diagnostic clinic, if indeed it is related to a particular disease will be paid for by the health care. We -- a lot of the programs that we put together in terms of guests are all free. The doctors and the staff from the different organizations, we've asked them to come and present. We have a couple of a small cost for that. But for the most part, the committee is really -- has really tried pare down the cost to the very minimum and the essential that is needed. Do you want to go through --
>> okay. Judge, very quickly, one of our committee members, lolly jones is here, she actually did the costing for the health-wise book. She's got your figures.
>> okay.
>> the health-wise are these that we passed out.
>> I still have mine.
>> yes, I do, too. I did make a call to the vendor, the provider. They do cost a little bit, they are $7.12 each, that is for a quantity of one to 999. We do get a price break if we were to buy over a thousand books, those then would cost $6.03 each. They do have health-wise books in spanish available, also, if we need that. Other books as well. But the cost on the book itself that we provided in the past is $7.12 each.
>> [indiscernible]
>> [laughter]
>> thanks, lolly.
>> thanks.
>> the cost that we have identified in association with the wellness program, including the health care festival, is use of the lab that the -- the mobile lab from the lions' club, which is a nominal amount, $200. The committee felt when the walking groups are formed that possibly we wanted to have some way of measuring how far they walked, as part of the performance measures. So anticipated purchasing pedometers and lee found some for about 5.60 I think is the last,.
>> yeah.
>> $5.60 each, if we purchased 600 of those it would be $3,360. That would serve as a measure -- would measure the distance walked each day.
>> okay.
>> I don't know if I saw it on tv in canada or here, two different places, but isn't special k or something doing some kind of an offer where you can get a freeometer, it's like a free $15 pedometer if you buy their cereal. I don't buy cereal so I don't know if that's the going rate for a box. That's something that we might look into. Donate all of the boxes of cereal to the food bank or something like that.
>> okay.
>> is walking on your treadmill considered part of the walking program.
>> it is for me, judge [laughter]
>> I would think so. [laughter]
>> depends.
>> any time your footings down when you have this pedometer on your belt, it counts. And the first day that I wore one, I did 4600 steps. What they say is that we generally without doing any extra exercise do between two and 4,000 steps a day.
>> I have already taken one, just handling it. [laughter]
>> they recommend in order to have some weight loss that you do 10,000 steps a day.
>> uh-huh.
>> I found that the second day I wore it, that I do a 2 and a half mile walk in the morning, you do about 10,000 steps a day with that. So -- you get where you -- you know, you kind of look at it, you know, see how many steps that you have done, how many stairs that you have climbed it all counts as just steps.
>> it's interesting if wear one on the weekend, Saturday morning get up, put your pedometer on, start walking, at that night take a look at it. You will find that you walk a considerable distance if you park away from the building, take the stairs instead of the elevator, things like that. They are a good tool to measure your walking distances. We will look into the special k --
>> yeah.
>> I can't remember where I saw it on tv, but I saw it.
>> the -- committee presented to court last week a discussion about reimbursing one-half of a gym membership up to a cap of about $100. We talked about probably for more than 400 individuals would join a gym and complete a year of involvement or a year of participation. But you'll have some coming on and dropping off during that year. So this breaks down the reimbursement by individual, by quarter I should say. So when you look on page 6 and you s really 400 individuals paid out over a quarter and amount if it reached that level the amount would be $40,000. Of course that -- that can somehow be controlled or capped or changed. I think the committee is still kind of looking at this.
>> I like that approach. I really do. And it depends on if a person wants, wherever they want to go, they can just apply that and -- and sort of like a partnership between the -- excuse me, we need to clean up our air, too. [laughter] (clearing throat) kind of a partnership between Travis County and you know, and however long we go, you know, I think that's still a --, you know, kind of a contribution to -- to getting healthy and staying healthy.
>> let me make sure that I understand this number. In terms of the 40,000, that's priced out how? I'm -- I want to make sure that I understand the asterisk.
>> it's -- it's 400 individuals, but broken out by quarter because you will have -- we didn't want to say specific individuals and somebody drops off and another person comes on. We want to be able to adjust the -- the quarterly reimbursements. So it's broken out 400 individuals, but paid out quarterly. So it's four times 400, 1600 reimbursements would be the maximum, is that more confusing?
>> yeah. What -- get me back to any one of those persons, what would their cap be on the monthly, is that the 25?
>> their cap would be $100 per year, paid out $25 per quarter.
>> per quarter, got it. Thank you.
>> the -- the next item is -- something that was provided to us by rick kosper, going to be a representative of tcso. He is putting together a great program, he's going to utilize or trying to utilize --
>> we don't want to do these fast ones, do we?
>> somebody told me that they are now serving nutritious meals.
>> depends.
>> that book is used. It's a 90 day journal that measures everything from your caloric intake, exercise, done morning, noon, evening, it indicates the medication to make sure that you are taking the right amount of medication. It serves as a journal to track your daily activity for 90 days. It provides valuable information on calories, grams of fat compared to saturated -- I guess what is it? Saturated, you know more about that stuff than I do. [laughter]
>> okay. I just know that if there's any count there you are not supposed to eat it. It's a -- it's a good tool to use. I know tcso is looking at that. Also, they are putting together an excellent program on wellness and it's going to include nutrition. So it's one of the developing -- department developing a wellness program that will fit well with the overall wellness program the county is adopting. But that looked to me to be a valuable tool to be given to employees to track their progress in their wellness program in the projects that they will be taking. The cost of that, we just got that in ... For 500 copies would be $4,300. It's $8.60 a copy. And they are a valuable resource information. Even after the 90 days, there's information in there that would benefit employees and really anyone because it's -- it serves, it has got a lot of resource information there. So ... We included that in our budget, our cost projections to the court. The -- the other items are more of a miscellaneous nature. The total amount that we are anticipating it would cost for the fiscal year for the wellness program is 5400 -- $54,560. And in talking to p.b.o. And I think barbara has got some information on use of -- of the 526 funds -- barbara do you --
>> the way that we wrote the chapter 17 language, does not seem to cover withdrawals for wellness. We talk about authorize withdrawals being program claims, which means doctors' treatments, rehab treatments, claim for administrative expenses which is where I was hoping that I would find it, but that is the compensation paid to our staff who do work for the plan. The third party administrator and any expenses that relate to financing that is necessary for us to do if we suffer a large claim that we don't have the mope for when it comes -- money for when it comes in or a large number of large claims, or the cost of insurance that relates to this program. It is not -- the fact that it is not in here at this point as a expense that can come out of that fund doesn't mean that this can't be amended so that it would be able to come out of the fund in the future. In fact the court may want to consider amending it so that we can use the -- or benefit from the legislation that the last legislature proposed in terms of program insurance is out there as well. So there's a number of things that we could consider at the same time that we -- that we consider this if we wanted to make that kind of a change and the resolution does contemplate us having a wellness program. It just didn't put authorization to pull funding for that out of this fund.
>> the 54,000 is -- approximately -- is an estimate. We have still to I think sharpen our pencils on this particular number and make sure that all of the costs are included, but that is what the plan is for the development and continuation of a wellness program. We have several members of the committee, which you -- which you know or have introduced themselves. If you have any questions we will willing to answer those at this time.
>> questions?
>> can you all tell me the difference between a cheesey gordita crunch, 560-calories and a supreme at 470.
>> I think it -- yeah [laughter]
>> one sounds fried.
>> [laughter]
>> that's the only thing that I can think of, sounds fried, the other sounds like a wrap.
>> anything gordita.
>> yeah.
>> [laughter]
>> gordita, yeah.
>> we will make it a gordito.
>> judge, I do have a question about -- I guess when we got this thing started, I mean I'm -- I'm all for it. Work-out wise and eating habit-wise. I don't know that I was headed in the direction that I wanted to spend $54,000 I mean as -- really headed this thing for people's lifestyle, number one, number two to see if it might alter the increase that we see happening with our health insurance. We all know that's going to be pretty tough to identify. But especially if we don't really have a real starting spot where people are, you know, really letting themselves know exactly where they are starting, where they are trying to get to. I mean which is the reason why i've always said that gyms are -- they are great if you use them. And they are always great when you start out because everybody is so, you know, energized to get out and to exercise. But keeping it going is the thing too so I would be -- I just want you to know that I would have a very difficult time paying for gym time unless somebody was going to show me a way that you really could quantify what somebody was getting out of that.
>> we struggled with that particular question. In fact we gave the issue of metrics to p.b.o. And leroy. We went all the way from having each employee that is going to participate go through a series of -- not a series, but some tests, very simple, you know, your cholesterol, your sugar, blood pressure, those sorts of things and be able to measure them at the beginning of the three-month period and at the end. That is one item that we discussed all the way to how much did you walk or how many times did you exercise? We gave the task of creating some sort of a pledge form to the county attorneys so that we were able to somehow document that in that three-month period, say for every month that you applied for reimbursement, that we had some documentation of the times that you went and if you didn't go the number of times perhaps you didn't get reimbursed. Those are the finer details, I think that we are still, the committee is still discussing, discussing, haven't come up with a definitive measurement for success of a wellness program. Is it just the number of pounds that you lose, the steps that you take. We all know that weight and exercise now overwhelmingly are related to wellness and health. That's very general. Or do we go down to the cholesterol, your blood pressure, your blood sugar and those sorts of --
>> stress.
>> -- stress or just a general survey of I feel better after participating in these classes and doing this activity. So we understand exactly what you are saying and I think the committee had a lot of discussion and if there's any direction from the court we are certainly willing to hear it.
>> some of the discussion had to do with the gym aspect of we don't want to start a pilot that we can't afford to do for the entire staff. In other words, we have about 4,000 employees, $100 year is $400,000, there were committee member that's asked: is this the biggest bang for the buck? Can you get the same thing with encouraging people to walk three miles a day with a pedometer and a little bit of competition. As alicia indicated there was some conversation on the committee about, you know, the aspects how much the court wants to fund and if in fact there's a limited budget, what would we prioritize within that budget among these various things. We do have, I assume we've got probably the same average on our staff that are already members of gyms, maybe 10%, three or four hundred people, if in fact those 3 or 400 people are the ones that get reimbursed you are not going to change the wellness of the overall staff. So maybe you take designated employees that have some challenges that might be benefited from, you know, other type of activities. So I think that's the question there.
>> leroy, with that I guess alicia, in fact the -- all of the staff there, has there been any comparison I guess looking to for other governmental entities that have participated financial, money-wise, into a wellness program? And if so, what -- you know this is a pilot of course, but they had to start also at a starting point, what were the benefits of that, if we have any data on that, I don't know if we do or not, but it may be something to look at. Not saying I'm opposed to anything, but it just appears to me that we can look to see what benefits other governmental entities have had in this. Really when we looked at this even into the next budget cycle, we ran into some road block type of situations here, we were trying to balance, look at the budget. But of course looking at -- performance based pay or -- as far as paying our employees, or on the other hand looking to the health care compensation that we felt that the employees really also needed, which is very critical, so I -- I don't want to run into that kind of situation this coming here whereby we are unable to pay our employees, but of course we still need to take care of the compensation as far as health benefits are concerned. So -- so I'm kind of looking at -- success rates of an investment by a governmental entity in a wellness program whereby they've had significant in-roads into that. I don't know if we have any data, if you can maybe look into that. You may have already done it.
>> we did conduct a survey, of public entities who had wellness programs. The one overwhelming thing that we do find, if they had a wellness program they either expanded or continued the program, although they did not have a way of tying it directly to any savings that they may have realized in their health care costs. I think the -- and I don't have -- I can't locate a copy of it, but I can provide that to the court. Bring that back next week to answer your question more specifically.
>> I would appreciate that if you could. And thank you again for that, for that answer.
>> we --
>> go ahead, I'm sorry, dan.
>> another part of the survey showed that wellness programs are all over the map. It's everything from just saying that you have one to something sophisticated as the one that we are trying to put together. They are varying and very different as defined by the organization.
>> barbara, do we think that we have the authority to spend public money on on employee recognition for wellness achievement?
>> if you do it as a -- if you do this, then you will receive that and you take the risk of every employee in fact do -- if you lose 10% of your weight, you will get $10. And every employee lost 10% of their weight and you paid everybody $10, if you do it in that particular mode, then yes you have the authority to do it. If you say we may give you something if you improve, then you haven't got a contractual arrangement there and it would -- it would be difficult to defend.
>> okay. If we say we'll give you a dollar a pound for every pound that you keep off, for at least 90 days, and we do that across the board, we could do it.
>> I think that I would make a year based on the information that we --
>> I guess my thought is I would rather spend it on something like that than gyms and exercises. The other thought that I have is that early on, my thinking was that if we really got the information at a sort of specialized level, then at least we would have the excuse for saying or to say I really didn't know what to do. Those that have gymnasiums at home, I mean, I pay for a gymnasium for years, I really seldom went. Got more exercise equipment at home now than I use. But I do use some of it, see? So I don't know that the gym part would help me. But it would help me to get information, feedback, input from a person who knows a whole lot more about my particular problem than I have. And when I look at this, we really are spending the bulk of the money, even if we get past the gym, then winter looking at equipment -- then we are looking at equipment, sort of devices that are helpful, but I'm wondering, you know, the law seems to make sense, the county gets away from the specialize -- that kind of gets away from the specialized approach I think we were taking. Let's take this up next week. The next thing if we are going to spend $45,000, I would rather try to put it in the hands of those who took the wellness program seriously, got out there and demonstrated that seriousness, and if not immediately in the long term really kind of help us better manage employee health insurance costs, see what I'm saying? So I think the challenge it's to figure out a way to do that.
>> yeah.
>> the other thing is, you know, with a little bit more than 4,000 employees, the approach that I have in mind is would enable us to identify and reward those who really get out there and take it seriously, make the sacrifice, show results. And in my view, even if the amount exceeds what we have down here for the gym training, I think the investment would be better. We would be paying for results, really. We would be rewarding results.
>> does this figure, let me ask, did this figure a little more than $54,000, for the pilot, does that also include I guess some of the recommendations, significant ones, as far as diabetes is concerned, have a person that specialized in diabetes whereas opposed to just a practitioner that really may not have the in-depth knowledge about how you deal with diabetes, just for an example, there are other categories other than diabetes that need specialties. So would this figure include that? As far as specialty? Is that something -- I'm sorry, go ahead.
>> yes. Yes, sir.
>> okay.
>> we did anticipate that everyone that was paid for any training had experience, education and background in the particular area that they were going to teach. Maybe diabetes, maybe nutrition, maybe -- may be training, physical training, may be a podiatrist, but, yes, sir, we expected that each individual that trained or offered training would have education, expertise and a background in that particular -- in their particular area.
>> okay.
>> surprisingly enough, people need to be trained on how to use some of that weight lifting equipment. Because if you use it wrong, you hurt yourself.
>> yeah.
>> that adds on to the problems that -- health problems. And so -- so that would be another training, you know, that -- or expert that we'd have to have to show people how to use weight lifting equipment. But still the other thing is what's -- what still remains for me is that the issue is still there that if we don't do something about this, then we won't have the money available for raises.
>> yeah.
>> that still remains there. And if all of us don't do something about this, in -- in whatever way we can, at price that's we can afford ourselves, then we are not going to get out of that. That's still there.
>> yeah.
>> we will have to continue investing the money in health benefits instead of raises.
>> yeah.
>> that's still there.
>> there is different ways that you can cut it. Maybe it's not 400 people. Maybe it's 100 people where you have documentation that they are attending on a regular basis. So -- or they pay for their membership, we provide training. The weight training and the specialized training. So I think there is way that's we can identify the proposal.
>> or we can start out with the walking program and see what develops.
>> yeah.
>> it could be that we are assuming needs that employees have without it coming from them. So if we start out with the basics, walking, institute the specialist that we need to talk to, let's try it.
>> the idea about the incentives related to the results. The reality is it doesn't matter if you do your walking, somebody does the walking on the fifth floor of this building and that's how she gets her steps in. Or whether it's on a treadmill at home. Queen of jazzercise, everything has to find their own thing that works for them. You can't preassume that everybody is going to go to a gym. I will never go to a gym because that's not the atmosphere that I love. I love the atmosphere at my rec center with the same ladies that I have been taking jazzercise with for 20 years, that's my comfort zone. Somebody else's comfort zone may be walking at town lake. We need to find what works for everybody.
>> what's the equivalent of -- if you lose a pound in weight, 10 pounds, say you are doing pretty good. What's the equivalent in body fat? Or is there one? So for those who are kind of thin like dan mansour --
>> thank you, judge.
>> -- who basically may not want to lose weight, but may want to lose fat and replace it with lean muscle mass which is just as healthy for some, right.
>> there is a measure for body fat index.
>> why don't we try to put in place a little approach like that where we measure you initially, you are in this program, we measure you initially, at some point when we make the determine nation is weather we make the call. I guess that would be -- it is now -- it will be February before we get this up and going. Six months from that, is August, what do we want to say? Like September? Do we want to make it this fiscal year, right?
>> uh-huh.
>> through the summer would be if we say the last week of August, then let's put in plagues a way to measure and reward -- then let's put in a place a way to measure and reward participants at that time and try to put in place where we focus on results, give you a way to formally end rom at any time between now and then and try to reward for weight loss as well as fat loss, muscle gain. I don't know that we would want to do both of them. So either/or I guess. And if we -- we can measure both of them at the beginning of the program, right?
>> uh-huh.
>> and then maybe we can focus on this other stuff that we are looking at. I have in mind taking out the gym training piece. I would think if I looked at the average taxpayer in the eye, that piece would be more difficult than the others because, you know, a lot of folk in the program already, a lot of them have stuff at home.
>> uh-huh.
>> the other way appears to me to be fairer up front.
>> yeah.
>> results.
>> yeah.
>> this would be based on individual goals such as smoking cessation, whatever those goals are.
>> right.
>> I guess if you just stop smoking, one question is how do we certify that, then I would think that would be worth something, wouldn't it? What would be a fair amount? And as long as we did that for all smokers, barbara, I hear you saying we can do it.
>> and you say it ahead of time.
>> you enroll in the program, we have to know that you have formally enrolled in the program, application form enrollment form, something like that, real simple, so we know who you are, what you say you're going to do, if you do it we recognize that, if you don't do it then good luck next year.
>> uh-huh.
>> but I think -- [laughter] -- we do have to be careful with that because I think alicia found out, I mean, which was a great point, I mean, you have got a non-smoker that says this person over here is getting something, I don't smoke, what are you going to give me? I'm not fat. What do I get for that? I mean I work out every day, I mean, I watch what I eat, I'm -- you know what I want a healthy lifestyle because I want to be able to come to work and perform and this and that. If you really, if we start identifying who we are going to give things to because you know what you really have an issue here we are going to pay you for it, I don't think -- I think it all really gets back to we are asking you to be as healthy as you can. We are willing to provide walking deals, experts that come in and give you classes, whatever we can do within reason but bottom line this stuff is an individual -- is an individual thing. I'm all for us trying to give people as many tools as we can as an employer, because that's really what we are, I mean, in this instance. I think that that's -- I don't think anybody, in the public would -- you know, would squawk about us trying to do that with our employees, especially if we are trying to do that from the standpoint of health insurance premiums and that kind of a deal. But I do think that it's a great idea to start the things like the walking, the -- that we can could for nothing. I mean that I would think somebody would buy their own pedometer if they were really that serious about it or buy special k, whatever it takes to get it. Or one pedometer gets out there, everybody walks the same step, I got it, we walk it.
>> share it. [laughter]
>> I think the taxpayer is going to be a little bit more selfish. I'm thinking if we are spending $31 million a year on employee health insurance, I don't see that dropping to 21, but I'm certainly hoping that it doesn't rise at the same level that it did last year to this year. And what I'm hearing is that some of us suffer from diseases that really are costing and we need you to do a better job of managing those. So I'm trying to figure out a way to invest a little in public dollars to provide incentive for employees that do that, but we need to do it even handedly. Let's think about it between now and next weekend. To the extent that we can put together like a written proposal, it will probably help. I think that I hear the court saying that we really ought to back off the reimbursement for the gym and training or put it down as a last option, right? Unless we think that there's no way for us to achieve the good results that we have in mind without doing that.
>> or just provide the training piece and not the gym so that it is -- becomes the partnership.
>> that's fine. And really I'm still thinking if you are on your owning out and do the gymnasium and achieve the results, it may be the incentive bonus you get pursuant to the up front agreement would be more than what you would have been entitled to if we followed a proposal like this.
>> what I want to do it make it affordable for everybody. If you can't afford a gym, you can always walk. Walking is, you know, is a really good exercise. And so -- but the combination of diet and exercise is what, you know, is the basis for everything whether you have a disease or not. And I think for women especially the bone density is extremely important, but diet and nutrition are still at the basis of everything. So we need to get people to be -- to move and not be so said terri. So -- sedentery, that's the big deal.
>> okay. We apologize to those assistant county attorneys who were headed this way at 11:00. But we will get this there afternoon. Move that we recess until 1:30.
>> second.
>> all in favor? That passes by unanimous vote. We appreciate you all's work on the wellness committee. Thank you very much.
>> thank you.
Last Modified: Wednesday, January 14, 2004 7:18 AM